Infant Formula

How you feed your baby is an important decision. The Grey Bruce Health Unit supports all families by providing information based on facts. This will help you make an informed decision.

There are many reasons why some mothers give formula to their babies, including:

The baby may have a medical condition and needs to be formula fed

The mother has a medical condition and is unable to breastfeed her baby

The mother and baby are separated from one another and the mother is unable to get enough breastmilk to her baby.

It is important to remember that the decision not to breastfeed can be difficult to reverse or change. If you wish to offer your child breastmilk now or in the future, it is important to continue to remove breastmilk by either breastfeeding or expressing by hand or pump. For more information on this see Breastfeeding Matters.

Know the facts

Research continues to show that there are health differences between feeding infant formula and breastmilk. We know now, more than ever, how important breastfeeding is to you and your baby’s health. Babies who are not breastfed have a higher risk of:

Gastrointestinal infections that cause diarrhea

Ear infections

Respiratory tract infection like colds and pneumonia

Sudden infant death syndrome (SIDS)

Research also suggests that breastfeeding protects against obesity and diabetes later in life.

Combining breastfeeding and infant formula

Once you make the informed decision to formula feed, it is important that you know how to safely prepare and store infant formula.

Infant formula options

Any cow’s milk-based infant formula will meet your baby’s nutrient needs, including generic brands. If you choose a low-iron infant formula, talk to your baby’s health care provider to make sure your baby is not at risk for iron deficiency.

Young children, especially infants, are vulnerable to foodborne illness. Breastfeeding is recommended as breast milk is the best source of nutrients for your baby and can help boost the baby's immune system. If a baby is not breastfed, liquid infant formula is an acceptable alternative. Liquid concentrate and ready-to-feed formulas are sterile products and for this reason the first choice when choosing a formula. Powdered infant formula has been linked to illness among infants due to contamination with harmful bacteria. Proper preparation, handling and storage practices are important to protect you baby from bacteria-related illness. For caregivers and parents who may not have access to liquid infant formula, or when a suitable liquid infant formula is not available, Health Canada states that powdered infant formula can be used if it's prepared properly.

Did you know...

Sterilization and infant formulas

For safety, children at high risk of health complications should be fed commercially produced liquid infant formula and not powdered formula. At-risk children include those born prematurely, at a low birth weight, or with a vulnerable immune system. If you absolutely have to feed your at-risk child powdered formula, bring your water to a rolling boil for two minutes, then pour it out into containers no larger than one litre and cool it to no less than 70°C before adding the powder.

Infant formulas marketed as organic, follow-up or second stage, made with prebiotics, probiotics or DHA fats, or made with “partially broken down” proteins are not necessary.

The following are not substitutes for infant formula and can be unsafe:

Cow’s or goat’s milk (raw or pasteurized)

Soy, rice or almond beverages

Homemade evaporated milk formula

Enfagrow®, Baboo® milk and Pediasure®

Since formula is a manufactured food, there is the possibility of safety issues. Health Canada’s Healthy Canadians is a website that provides safety and recall alerts (use search term ‘infant formula’). Consider signing up for their health and safety updates.

Safe feeding equipment

Use glass or BPA-free bottles and nipples that have no cracks, discolouration or loose material that could break off. If you notice signs of wear, throw them out.

To make feeding equipment (e.g., bottles, nipples and tongs) safe, boil them for at least two full minutes at a rolling boil. Note: there is no safe baby’s age to stop boiling equipment.

Follow the manufacturer’s instructions when using a commercial sanitizer. See How to clean and boil feeding equipment steps on page 3.

Should Fluoridated Water be used for Infant formula preparation?

Yes – as long as that water has safe levels of fluoride in the recommended range between 0.6 and 0.8 parts per million (ppm). Fluoride at these levels has been proven to help with your baby’s developing teeth and dental health for the whole family.

Owen Sound maintains its water supply at approximately 0.7 ppm. It is the only municipality in Grey Bruce that adds fluoride to its water supply.

Fluoride occurs naturally at levels from close to zero, to over 2.0ppm in this region. Ground water in the far west of the region tends to have higher levels.

If fluoride is above 1.5 ppm in your local water, then it may be advisable to use a different water source for reconstituting infant formula.

You can check with your local municipality if you are on their water system to confirm local fluoride levels.

Well water may have naturally high fluoride levels. It is recommended to have well water tested (offered by private labs for a fee) to confirm levels before mixing with infant formula.

The main concern about high fluoride levels is Fluorosis – a discolouring or mottling of tooth enamel. Fluorosis is not a disease, but rather an aesthetic issue. Current scientific literature confirms that dental fluorosis is unlikely to occur at fluoride levels in the safe range of 0.6 to 0.8 ppm.

Safe water options include:

Cold tap water with safe fluoride levels confirmed

Bottled water that is not fortified or carbonated and states the level of fluoride and nitrate on the label

Well water tested for bacteria and safe fluoride and nitrate levels

No recommendation can currently be made for or against the use of distilled, deionized, demineralized, purified or “produced through reverse osmosis” water sources. Many of these waters may have had essential minerals removed and, as a result, may not be optimal to prepare infant formula.

Boil the water

Bring water used to prepare infant formula to a rolling boil for two full minutes. Be aware electric kettles may not keep the water at a rolling boil for two full minutes. Once boiled, the water can be stored in a tightly closed container (that has been cleaned and boiled for at least two minutes) for:

24 hours at room temperature

48-72 hours in the refrigerator

If you are preparing powdered infant formula for later use (not feeding baby right away), use boiled water that is no less than 70° Celsius to lower the risk of bacterial contamination. This means once you boil the water, do not let it sit for more than 30 minutes before mixing in the powder.

Preparing and storing infant formula

Read and follow the instructions when preparing infant formula. Too much or too little infant formula can make babies sick.

For powdered infant formula, use the scoop that comes with the formula container. When you measure a scoop, it should be flat across the top.

Correct

Incorrect

If you choose to warm the infant formula, warm it for no longer than 15 minutes to room or body temperature by placing the bottle:

Under warm running water

In a bowl of warm water

In an electric bottle warmer on a low setting

Avoid using a microwave to warm bottles as it can cause “hot spots” and burn your baby’s mouth.

Storing infant formula containers

To lower the risk of bacterial growth and to retain the nutrients, follow these tips:

Check the ‘best before’ date

Store unopened containers in a cool dry place

Avoid direct sunlight or freezing

Once opened, liquid concentrate or ready-to-feed may be refrigerated for up to 48 hours. See manufacturer’s instructions on how to store opened containers of powdered infant formula.

How to feed by bottle

Hold your baby skin-to-skin in your arms so that baby’s head is higher than his or her body. Make the most of this special time by looking into each other’s eyes, talking softly to your baby and smiling. Change positions often to give your baby different views of you. Hold the bottle parallel to the ground so that the nipple is ½ to ¾ full of milk. Near the end of the feeding when there is less infant formula left, tip the bottle up. Burp baby often (at least 1-2 times a feeding). Don’t put your baby to bed with a bottle or prop the bottle to feed.

Trust that your baby knows how much to drink and follow their feeding cues. When your baby starts to show signs of fullness, stop feeding. Avoid pressuring your baby to finish the bottle.

Signs that your baby may be hungry include:

Restlessness

Rooting (opening their mouth, searching to suck and sucking on contact)

Sucking on a hand

Signs your baby may be full include:

Sucking actions slow down

Losing interest or letting go of the nipple

Looks sleepy and calm

Rooting will stop

Turning head away

Your baby will drink more at some feeds and less at other feeds. They will go through growth spurts and drink more. This is not a sign to introduce solid foods. See Baby’s First Foods on our website for information on when to introduce solid foods. When you follow their hunger and fullness signs, you will feed them the amount that they need.

If you are unsure whether your baby is drinking enough, talk to your baby’s health care provider. Making sure they are growing well is one way to know your baby is getting the amount that is right for them. For more information on growth and development, see Growth and Development during the First Year of Life on our website.

Vitamin D – Vitamin D is added to infant formula. If you are combining breastmilk and infant formula, give your baby a vitamin D supplement of 400 IU each day. If your baby only drinks infant formula, they may not need additional vitamin D. Talk to your baby’s health care provider to see if they need a vitamin D supplement.

Tooth decay – If your baby falls asleep while bottle feeding, they have a higher chance of developing tooth decay, even if your baby has no teeth yet. Tooth decay can cause trouble with eating, sleeping and may even affect their adult teeth.

To lower the chance of tooth decay, wipe your baby’s gums or teeth with a damp, soft, clean cloth or infant tooth brush after each feeding or at least twice a day, even if your baby falls asleep.

3) Place equipment into a pot and fill with water. Make sure equipment is fully covered with water.

4) Bring water to a boil and let the water boil for at least two minutes.

5) Keep equipment in covered pot or place them on a clean cloth or towel on the counter to dry.

How to prepare liquid concentrate or ready-to-feed infant formula

When preparing infant formula, follow the preparation instructions carefully. Refer to the previous pages in this factsheet for safe water options as well as how to clean and boil the feeding equipment.

When feeding your baby, always follow their feeding cues. This means to feed them when they are hungry and stop when they are showing you they are no longer hungry.

1) Clean and disinfect the counter. Wash hands with soap and warm water. Dry hands with a clean towel. For ready-to-feed, go to step 4.

5) If you don’t feed your baby right away, you can store the bottle in the refrigerator for up to 24 hours.

2) Bring water to a rolling boil for two full minutes. Cool to room or body temperature.

6) If you warm the infant formula, check the temperature by dripping a small amount onto the inside of your wrist. It should feel lukewarm or room temperature.

3) For liquid concentrate only, add the correct amount of water in the bottle. Do not add water when preparing ready-to-feed.

7) Feed your baby based on their feeding cues.

4) Pour the desired amount of infant formula in the bottle.

8) Throw away any unused infant formula within two hours.

How to prepare powdered infant formula

When preparing infant formula, follow the preparation instructions carefully. Refer to the previous pages in this factsheet for safe water options as well as how to clean and boil the feeding equipment.

When feeding your baby, always follow their feeding cues. This means to feed them when they are hungry and stop when they are showing you they are no longer hungry.

1) Clean and disinfect the counter. Wash hands with soap and warm water. Dry hands with a clean towel.

6) Mix well by shaking, swirling the bottle or stirring with a sanitized spoon until no lumps are present.

2) Bring water to a rolling boil for two full minutes.

7) If prepared with water that is no less than 70°C, you can store the bottle(s) in the refrigerator for up to 24 hours.

3) If you are preparing bottles for later use (up to 24 hours later), cool water to no less than 70°C (about 30 minutes). You can use a food grade thermometer. If you are preparing a bottle to feed baby right away, you can let the water cool to room temperature.

8) If you warm the infant formula, check the temperature by dripping a small amount onto the inside of your wrist. It should feel lukewarm or room temperature.

4) Pour the correct amount of boiled water into the bottle first.

9) Feed your baby based on their feeding cues.

5) Immediately add the correct amount of infant formula powder to the water. If needed, use a knife (cleaned and boiled for at least one minute) to make a level scoop.

10) Throw away any unused formula within two hours.

How much formula does my baby need?

The amount of formula your baby needs depends on the size, age and activity of your baby.

In the first few days, you can expect your baby to feed very often (minimum of 8 feeds in 24 hours) and start with small amounts of formula (0.5 to 2 oz at each feeding). Their appetite will continue to grow as they do.

Your baby will get hungry more often during growth spurts, which occur at:

2-3 weeks

6 weeks

3 months

6 months

Infants and young children have small stomachs and need to be fed frequently, especially during growth spurts. This is not a sign your baby is ready for solids.

Allow your baby’s appetite to guide how much formula you offer. Babies know how much to drink. Do not pressure your baby to finish a bottle. Remember every baby will have a unique eating pattern.

Adapted with the permission of York Region Community and Health Services